Healthcare Provider Details

I. General information

NPI: 1679861256
Provider Name (Legal Business Name): BRIAN EUGENE PRATT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2011
Last Update Date: 10/27/2024
Certification Date: 10/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

458 N MAIN ST
CLAYTON GA
30525-4254
US

IV. Provider business mailing address

458 N MAIN ST
CLAYTON GA
30525-4254
US

V. Phone/Fax

Practice location:
  • Phone: 706-960-9550
  • Fax: 706-960-9551
Mailing address:
  • Phone: 706-960-9550
  • Fax: 706-960-9551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0078359
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: